Policy Directive Safe Administration of Liquid Medicines by Routes other than Injection Summary This policy provides direction to minimise the risk of patient injury or death from inadvertent parenteral administration of liquid drug doses intended for other routes. Document type Policy Directive Document number PD2012_006 Publication date 20 January 2012 Author branch Clinical Excellence Commission Branch contact Review date 30 September 2022 Policy manual Patient Matters File number H10/43697 Previous reference N/A Status Review Functional group Clinical/Patient Services - Medical Treatment, Pharmaceutical Population Health - Pharmaceutical Applies to Local Health Districts, Specialty Network Governed Statutory Health Corporations, Affiliated Health Organisations, Public Hospitals Distributed to Public Health System, Divisions of General Practice, Government Medical Officers, Health Associations Unions, NSW Ambulance Service, Ministry of Health, Private Hospitals and Day Procedure Centres, Tertiary Education Institutes Audience Administration;Clinical Secretary, NSW Health This Policy Directive may be varied, withdrawn or replaced at any time. Compliance with this directive is mandatory for NSW Health and is a condition of subsidy for public health organisations. POLICY STATEMENT SAFE ADMINISTRATION OF LIQUID MEDICINES BY ROUTES OTHER THAN INJECTION PURPOSE There have been a number of incidents resulting in serious injury where doses of oral liquid medicines have been administered parenterally. These incidents have occurred through the use of parenteral syringes to prepare liquid medicine doses resulting in inadvertent administration of the dose via the incorrect route. The outcomes of this type of incident may be catastrophic and can be fatal. This policy has been developed to minimise the risk of serious injury or death from the parenteral administration of liquid doses of medicines intended for other routes (principally oral or enteral). MANDATORY REQUIREMENTS • Oral/enteral dispensers (also called oral/enteral syringes) or graduated medicine cups are to be used to prepare, measure and administer all liquid doses intended for: • Oral and enteral use • Inhalational, intranasal, topical, or rectal use where measurement of volume is required • Injectable medicines intentionally prescribed for non-parenteral use • Devices used for withdrawing liquid medicine doses intended for non-parenteral use from their container must have connections compatible with the oral/enteral dispensers • Enteral feeding catheters, both nasogastric and percutaneous must have connections compatible with the oral/enteral dispensers in use. • No device intended for access to the gastrointestinal tract should feature a female Luer® connector (Luer-Lok® or Luer-Slip®). IMPLEMENTATION Local Health District Chief Executives • Assign responsibility for implementation of the standard and maintenance of the use of oral/enteral dispensers in line with mandatory requirements within the Local Health District. Directors of Clinical Governance . Ensure systems are in place to: • Implement the mandatory requirements and standards. • Monitor compliance with the policy and standards. PD2012_006 Issue date: January 2012 Page 1 of 2 POLICY STATEMENT Hospital, facility, clinical stream and unit managers, Heads of Departments, Nurse/Midwife In Charge • Ensure systems and practices prescribed in this policy are implemented and sustained successfully. • Clearly identify and store oral/enteral dispensers separately from parenteral syringes. • Ensure that oral/enteral dispensers and compatible connectors are available at the point-of-care. • Monitor compliance and practices described in this policy. • Ensure compliance of staff with use of the devices as described. Directors of Pharmacy • Liaise with relevant staff to ensure supply of oral/enteral dispensers and compatible connectors are maintained in all clinical areas. • Ensure all clinical pharmacists and technicians are aware of this policy and ensure it is followed in all clinical areas. • Ensure all dose measuring devices issued to outpatients and those transferring to the community comply with this policy. REVISION HISTORY Version Approved by Amendment notes January 2012 Director-General New Policy (PD2012_006) ATTACHMENTS Policy Standard – Safe Administration of Liquid Medicines by Routes Other Than Injection PD2012_006 Issue date: January 2012 Page 2 of 2 Safe administration of liquid medicines by routes other than injection. POLICY STANDARD Issue date: January-2012 PD2012_006 PD2012_XXX Safe administration of liquid medicines by routes other than injection POLICY STANDARD CONTENTS 1. BACKGROUND ..................................................................................................................... 1 2. KEY DEFINITIONS ................................................................................................................. 1 3. ORAL/ENTERAL DISPENSERS - REQUIREMENTS ............................................................. 3 4. ENTERAL FEEDING SYSTEMS ............................................................................................ 3 5. LIQUIDS FOR INHALATION, INTRANASAL, TOPICAL OR RECTAL ADMINISTRATION .. 4 6. PROCEDURES ...................................................................................................................... 4 6.1 Obtain and stock oral/enteral dispensers which are: ..................................................... 4 6.2 Prepare and administer doses as follows: ...................................................................... 5 6.3 Labelling of non-parenteral liquid doses......................................................................... 5 6.4 Dispensing......................................................................................................................... 6 7. PATIENT EDUCATION ......................................................................................................... 6 8. REFERENCES ....................................................................................................................... 6 APPENDIX 1 – IMPLEMENTATION & COMPLIANCE CHECKLIST ......................................... 8 PD2012_006 January 2012 Contents page Safe administration of liquid medicines by routes other than injection POLICY STANDARD 1. BACKGROUND The policy statement and standards together provide direction to minimise the risk of patient injury or death from inadvertent parenteral administration of liquid drug doses intended for other routes. This policy mandates use of oral/enteral dispensers to measure and administer liquid medication doses by routes other than injection. Oral/enteral dispensers allow accurate volume measurement and prevent connection with injectable access devices. Use of dedicated devices provides a check against a medicine dose being administered by the incorrect route. This policy is relevant to all clinical staff involved in administration of medicines and applies to adults, children and neonates. 2. KEY DEFINITIONS Administration This includes all giving sets, administration lines and invasive monitoring line lines through which medicines and fluids could be administered. Barrel (of syringe) The hollow cylinder of a syringe in which fluids are measured Catheter A flexible tubular device for removing fluids from, or delivering fluids to, a body cavity. Calibration (the scale of a measuring instrument) an instrument divided into marked intervals for optimal measuring so that it can be read in the desired units. Dead space The volume of fluid remaining in the tip of a syringe after the plunger of the syringe has been fully depressed into the barrel. Enteral Fluids (nutrition or medicine) given into the gastrointestinal tract. Female (Luer) Describes the shape and size of the port which connects with a male Luer Connector connector. The standard shape of devices designed to access the vascular system. Hub/syringe The proximal end of a needle which attaches to the syringe barrel by adaptor means of a press-fit mechanism (Luer) or a twist-on mechanism (Luer- Lok). Injection For the purposes of this policy includes intravenous, intramuscular, intra- arterial, epidural, subcutaneous routes of administration Intravenous Parenteral drug and fluid administration into or within a vein or veins. Luer taper A Luer taper is a standardised system of small-scale fluid fittings used for making leak-free connections between a male taper fitting and its mating female part on medical and laboratory instruments, including hypodermic syringe tips and needles. It originated as a 6% taper fitting for glass bottle stoppers. Key features of Luer taper connectors are defined in the ISO 594/1:1986 standard.(BS EN 20594-1:1994). PD2012_006 Issue date: January 2012 Page 1 of 8 Safe administration of liquid medicines by routes other than injection POLICY STANDARD Luer-Lok There are two varieties of Luer taper connections: Luer-Lok and Luer- Slip.[4] Luer-Lok fittings are securely joined by means of a tabbed hub on Luer-Slip the female fitting which screws into threads in a sleeve on the male fitting. Luer-Slip fittings simply conform to Luer taper dimensions and are pressed together and held by friction (they have no threads). Luer components are manufactured either from metal or plastic and are available from many companies worldwide. "Luer-Lok" and "Luer-Slip" are registered trademarks of Becton Dickinson. In the literature a "Luer-Lok" style connector is often generically referred to as a "Luer lock connector" and